Mehrstärken- Kontaktlinsen Michael Wyss

Transcription

1 Mehrstärken- Kontaktlinsen Michael Wyss dipl. Augenoptiker FAAO kontaktlinsenstudio baertschi, Bern, Switzerland

2 Situation on the market

3 Blind-Date Get in contact with your patients, you have to invest in those relationships A good patient history goes a long way and needs a complete anamnese

4 Your expectations Living a realistic optimism Show all compromises of all forms of vision correction To cover 80% of the patients needs, leads in 100% success

5 Patients needs and wishes Listen very carefully and active Every single little something or habit is important Ask open questions Give your patient and yourself enough time

6 Patients needs and wishes

7 Additional objective Findings Lid, position and consistent Pupil diameter Depth of the anterior chamber Tear layer - quality and quantity

8 Forms of corrections Monovision Aplanate Systems Simultaneous Systems Translating Systems

9 Monovision Follow-up Near target with a plus trial lens in front of the non-dominant eye Target for distance with the same lens situation If the vision s not comfortable in one of these situations, consider other options

10 Modifide Monovision Necessary if intermediate distance is missing The dominant eye still need to be corrected as good as possible for distance Adjust a bifocal solution in the nondominant eye

11 Aplanate Systems Using aspheric optic designs, leading in the correction of the optical aberrations, achieve a better depth perception Useful up to max. Addition of + 1.5dpt Not centered or dehydrated contact lenses will extremely decrease vision acuity

12 Simultaneous Systems Concentric progressive / degressive correction changes from center to the periphery (aspheric / multifocal designs)

13 Multifocal, Simultaneous by Bach Optik

14 Multifocal, Simultaneous by Bach Optik

15 Simultaneous Systems Concentric rings of distance and near correction (bifocal)

16 Bifocal, Simultaneous by Bach Optik

17 Indications for simultaneous CL Deep lower lid position / small lid opening Distance and intermediate vision tasks Requires near vision in other than 270 Big pupil diameter / flat anterior chamber

18 Disadvantages of simultan. CL Decreased contrast sensitivity, especially with uncorrected astigmatism Dehydration of Soft-CL decrease contrast sensitivity additionally All designs are more or less pupil size related

19 Simultaneous, multifocal Design Low Addition up to +1.75dpt Hyperopia High night vision demand Low / moderate astigmatism

20 Simultaneous, bifocal Design Higher Addition than +1.75dpt No intermediate vision demands Minimal night vision demands

21 Simultaneous CL fitting pearls Golden Rule: Assess vision binocularly Excellent lens centration Gas permeable contact lenses (GP) thin edge and big diameter (perilimbal / miniscleral GP Designs) DK >100, makes Continuous Wear possible (geriatric / pediatric solutions)

22 Simultaneous CL fitting pearls Soft-CL only available with very low DK s, except Purevision Multifocal Chose the near optic zone smaller on the dominant eye (Small adjustments in optic zone diameters lead in dramatic visual changes for your patient) Better contrast sensitivity achieved with lower Addition on dominant eye

23 Translating Systems Classical design as known from the bifocal spectacles

24 Translating Systems by Bach Optik

25 Translating Systems by Bach Optik

26 Indications for transl. Systems High contrast sensitivity demand High distance and near demand Moderate to high myopia and astigmatism Unrelated to pupil size and anterior chamber depth

27 Disadvantages of translating CL Moderate vertical movement of CL necessary And so, foreign-body sensation will be increased Intermediate vision demands not included

28 Disadvantages of translating CL Near target only visible in down gaze As a consequence distance vision not possible in down gaze Because of the amount of movement needed, normally impossible for soft contact lenses

29 Translating Design: fitting pearls Perfect fitted back surface (3+9 o clock staining) especially in cases with an astigmatic cornea topography Don t use a to big size of the vertical diameter of CL

30 Translating Design: fitting pearls Rapid drop of CL after blink, achieved by oval size of the CL in 90 The position of the lower lid in mind, preturn the Segment edge

31 Disposable contact lenses Near central, with degressive power changes (Focus Progressiv, Purevision Multifocal, etc)

32 Disposable contact lenses Distance central, multiple concentric rings (Acuvue Bifokal )

33 Disposable contact lenses Combination of distance and near central, with degressive or progressive Design (Proclear Multifokal System)

34 Disposable contact lenses You need to know the advantages and disadvantages of your used systems Play with the different available CLdesigns on the market After all, still pay attention to the fitting recommendations of the manufacturer

35 Disposable: Golden rule Excellent centration needed Assess vision binocularly, under normal light condition Now since 2008 Proclear in Astigmatic Design available DK mostly absolutely bad (HEMA!) Exception Purevision Multifocal (Dk/t 120)

36 Disposable fitting cascade Full power Addition on each eye Modified Bifocal: lower Add on dominant, full Add on nondominant eye Using different Designs: DC / multifocal on dominant eye NC / bifocal on non-dominant eye

37 Translating Soft-CL (Triton ) Manufacturer Gelflex, Australia

38 Translating Soft-CL (Triton ) Horizontal Diameter 14.5 or 15.0 Vertical Diameter or Central radius with diameter 14.50: flattest cornea radius plus 0.8mm All Parameters can be changed individually

39 Translating Soft-CL (Triton ) Consistent, position, sensitivity and the angle of the lower lid margin are important If the vision gets worth after putting the Triton on the eye, the CL is to steep fitted Pay attention on good translation in down gaze

40 Translating Soft-CL (Triton )

41 Transl. Soft (Viso Royal ) Translating Design like Presbylite GP Indication is given as by the Triton, but is distinguished by a more comfortable Design in the area of the lower lid

42 Transl. Soft (Presbylite soft)

43 The Future Siliconhydrogel, individual contact lenses in 3month or 6month replacement schedule Orthokeratology CRT Multifokal (Paragon) Nypon Mulftifokal

44 The Future Translating-Simultaneous Design (Falco Kontaktlinsen BA, Switzerland)

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